| NPI | 1306334289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CO MT.0021275) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2023-08-10 |